Position of the bones in an old unreduced dislocation forward of the radius. (Erichsen.)
Treatment.
—The treatment of elbow dislocations is based upon general and but slightly differing principles. It consists of a combination of traction with sufficient force, made with one hand, while with the other pressure should be made upon one or both bones in the desired direction; at the same time by a combination of swaying and rotary movements more or less massage may be given to the parts, by which complete reduction may be more easily effected. Anesthesia is nearly always necessary, not alone for the relief of pain, but to produce muscular relaxation, by which manipulation is materially assisted.
A peculiar form of dislocation of the head of the radius in young children has received considerable attention. It is produced by a firm pull upon the wrist or forearm, as in lifting or jerking a child by the forearm or hand. Pronation of the hand is usually a feature of the injury. It is probable that the head of the bone is pulled out of the orbicular ligament and displaced forward. The forearm is slightly flexed, movements of the elbow are very free, except that supination of the forearm meets with resistance. The displacement is rectified by a forced supination with traction. An epiphyseal separation of the head may simulate this injury. Such cases necessitate a few days’ rest in a splint, with the arm flexed and supinated, although recovery often occurs without particular restraint.
DISLOCATIONS OF THE WRIST AND HAND.
Wrist dislocations are rare, the posterior being more frequent than the anterior. It simulates the deformity of a Colles fracture, and is produced in a similar way. The deformity is more marked, the outlines of the various bones more distinct, except in front, where they may be masked by the flexor tendons. There is no alteration in the relations of the styloid processes. The forward dislocation may possibly simulate Smith’s fracture, the symptoms being the reverse of those above mentioned.
Firm traction, with pressure in the proper direction upon the carpus, will suffice for reduction of these cases. The subsequent dressing may be practically that of a Colles fracture.
The lower ends of the ulna and radius are sometimes dislocated from their proper relations. Reduction is easy, but rest and restraint are required for some time until the ligaments have recovered their tonus.
Of the carpus the os magnum is the only one likely to be displaced, it being occasionally forced backward so that it forms a projection on the dorsum of the hand. It requires extreme force to displace the carpal bones, enough frequently to produce other injuries at the same time, some of which may be compound. A carpal bone which cannot be reduced to position by pressure may be safely removed through an incision.
Of the carpometacarpal dislocations, the thumb is the most frequently displaced, usually in a backward direction. Traction and pressure suffice for its reduction. When the bone is forced forward it is usually as the result of direct violence. Wherever the base of the bone may rest it is easily detected, while pressure with traction suffices for its replacement.